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FIELD DOCUMENTS_FILE 1
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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5491
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3500 - Local Oversight Program
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PR0545028
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FIELD DOCUMENTS_FILE 1
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Last modified
12/6/2019 2:57:11 PM
Creation date
12/6/2019 2:44:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 1
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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SJGOV\wng
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EHD - Public
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.:,�, IZTORING WELL INSTALLATION REPOn",, <br /> Date: �� G moi' CONSTRUCTION <br /> Premise Address: 5��'W ` J-7 4- Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) . <br /> Inspector: 1a17-1Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> / /� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ` <br /> Driller: 1714 casing <br /> height <br /> Consultant <br /> -Q%r <br /> Geologist , yl�p � �� "' <br /> AE&E-GROUND C-GMTY480X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) �__ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> _ m <br /> = o <br /> slottad w <br /> SAMPLING .— <br /> saclon <br /> Holding Temperature ¢1191 P?o <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Method MATE RIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank ft. Screen ----ft <br /> - <br /> Storage <br /> size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n) <br /> Installation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />
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